Sexually transmitted infections among HIV-infected and HIV-uninfected women in the Tapajós region, Amazon, Brazil: Self-collected vs. clinician-collected samples

PLoS One. 2019 Apr 23;14(4):e0215001. doi: 10.1371/journal.pone.0215001. eCollection 2019.

Abstract

The anogenital prevalence of sexually transmitted infections (STIs) and the use of cervico-vaginal self-collected vs. clinician-collected samples were evaluated for the diagnosis of human immunodeficiency virus (HIV)-infected and HIV-uninfected women in the Tapajós region, Amazon, Brazil. We recruited 153 women for a cross-sectional study (112 HIV-uninfected and 41 HIV-infected) who sought health services. Anal and cervical scrapings and cervico-vaginal self-collection samples were collected. Real-time polymerase chain reaction methods were used for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium. A syphilis test was also performed. Risk factors for STIs were identified by multivariate analysis. The overall prevalence of STIs was 30.4% (34/112) in HIV-uninfected women and 24.4% (10/41) in HIV-infected women. Anogenital Chlamydia trachomatis infection was the most prevalent in both groups of women (20.5% vs 19.5%). There was significant agreement for each STI between self-collected and clinician-collected samples: 91.7%, kappa 0.67, 95% confidence interval (CI) 0.49-0.85 for Chlamydia trachomatis; 99.2%, kappa 0.85, 95% CI 0.57-1.00 for Neisseria gonorrhoeae; 97.7%, kappa 0.39, 95% CI -0.16-0.94 for Trichomonas vaginalis; and 94.7%, kappa 0.51, 95% CI 0.20-0.82 for Mycoplasma genitalium. Women with human papillomavirus had coinfection or multiple infections with other STIs. Risk factors for STIs were being ≤ 25 years old, being employed or a student, reporting a history of STI and having a positive HPV test. A high prevalence of STIs in women in the Tapajós region was found. Cervico-vaginal self-collection is a useful tool for STI screening and can be used in prevention control programs in low-resource settings, such as in northern Brazil.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Brazil / epidemiology
  • Cervix Uteri / microbiology
  • Cervix Uteri / virology
  • Chlamydia Infections* / epidemiology
  • Chlamydia Infections* / microbiology
  • Chlamydia Infections* / virology
  • Chlamydia trachomatis
  • Coinfection* / epidemiology
  • Coinfection* / microbiology
  • Coinfection* / virology
  • Cross-Sectional Studies
  • Female
  • Gonorrhea* / epidemiology
  • Gonorrhea* / microbiology
  • Gonorrhea* / virology
  • HIV Infections* / epidemiology
  • HIV Infections* / microbiology
  • HIV Infections* / virology
  • HIV-1
  • Humans
  • Mass Screening
  • Middle Aged
  • Mycoplasma Infections* / epidemiology
  • Mycoplasma Infections* / microbiology
  • Mycoplasma Infections* / virology
  • Mycoplasma genitalium
  • Neisseria gonorrhoeae
  • Papillomaviridae
  • Papillomavirus Infections* / epidemiology
  • Papillomavirus Infections* / microbiology
  • Papillomavirus Infections* / virology
  • Specimen Handling*
  • Trichomonas Vaginitis* / epidemiology
  • Trichomonas Vaginitis* / microbiology
  • Trichomonas Vaginitis* / virology
  • Trichomonas vaginalis